社区家庭医生服务模式对脑卒中患者管理效果评估

Evaluation of family doctor services mode in stroke patients in community

目的评估社区家庭医生服务模式对脑卒中患者管理效果。方法选取在北京市万寿路社区卫生服务中心就诊的脑卒中患者146例,随机分为研究组(77例)和对照组(69例)。对照组进行常规药物治疗和随访,研究组进行家庭医生服务模式干预,干预时间为1年,干预措施包括健康知识干预、用药干预和指导康复训练。对患者脑卒中知识的知晓率、脑卒中危险行为情况、运动功能和日常生活活动能力进行评估。结果研究组患者在干预后脑卒中确诊标准知晓率,脑卒中是可以预防的,高血压、糖尿病、高脂血症、房颤是脑卒中危险因素,成人每日食盐摄入标准的知晓率以及吸烟和过量饮酒是脑卒中危险因素的知晓率(分别为80.52%、97.40%、90.91%、88.31%、89.61%、84.42%、89.61%、100.00%、98.70%)明显优于本组干预前(42.86%、51.95%、36.36%、32.47%、29.87%、24.68%、35.06%、49.35%、50.65%)和对照组干预后(52.17%、63.77%、53.62%、43.48%、40.58%、37.68%、52.17%、55.07%、59.42%),差异均有统计学意义(均P<0.05);在食盐控制、饮食规律、吸烟、饮酒、适量运动等方面明显优于本组干预前和对照组干预后(P<0.05);研究组干预后Fugl-Meyer运动功能评分(64.5±23.1)分和Barthel指数评分(76.4±17.6)分明显高于本组干预前(33.21±22.72)分、(37.62±23.67)分和对照组干预后(46.3±24.6)分、(59.8±18.3)分(P<0.05);研究组脑卒中复发率发率为3.90%,明显低于对照组的15.94%(P<0.05)。结论社区家庭医生服务模式可提高脑卒中患者相关知识知晓率,降低患者行为危险因素,提高患者运动功能和日常生活活动能力,降低其复发率。

Objective To evaluate the control effect of family doctor services mode on stroke patients in community health service center. Methods A total of 146 stroke patients were collected and randomly divided into case group and control group, 77 patients in the case group and 69 in the control group. Patients of the control group were treated using conventional methods, and patients of the case group were treated using the family doctor mode which included health education, intervention for rational of drugs and rehabilitation training. Results The awareness rates on the diagnostic criteria for stroke, risk factors of stroke such as high blood pressure, diabetes, atrial fibrillation and hyperlipidemia, and adult daily salt intake standard of patients in the case group after intervention were significantly better than the control group and before the intervention(P<0.05). The patients in the case group after intervention did better in the salt control, diet, smoking, drinking, moderate exercise as compared with the control group and before intervention(P<0.05). The Fugl-Meyer Assessment(FMA)and Barthel Index(BI) scores of the case group after intervention were significantly higher than those of the control group and before intervention(P<0.05). The recurrent rate of stroke in the case group was significantly lower than that in the control group(P<0.05). Conclusion The family doctor services mode can increase the awareness rates on stroke, decrease the risk behavior, increase the motor function and activities of daily living of patients and decrease the recurrent rate of stroke. It is worth to be popularized in the community.